Anaesthesiology intensive therapy最新文献

Introduction: Cricothyrotomy (CTM) is currently recommended as the preferred method due to its ease, speed, and safety in life-threatening airway emergencies where standard tracheal intubation and mask ventilation fail.

Material and methods: This retrospective study analyzed 33 cases of "can't intubate, can't oxygenate or ventilate" (CICOV): 12 of percutaneous dilatational tracheostomy (PDT) and 21 of CTM. The CTM group was younger (median age 44) and mainly consisted of trauma patients. The PDT group was more diverse and procedures were performed by anesthesia and critical care consultants.

Results: Initial success rates were 100% for PDT (12/12) and 86% for CTM (18/21), with one conversion from CTM to PDT. No perioperative complications occurred in the PDT group, while the CTM group experienced two cases of false tracts requiring re-do and three cases of bleeding. Immediate mortality within 24 hours was reported in 5/19 CTM patients and none in the PDT group. Successful liberation from mechanical ventilation at hospital discharge was achieved in 6/12 PDT patients and 11/21 CTM patients. Among the 21 CTM cases, all 16 survivors underwent subsequent tracheostomy. Tracheal decannulation occurred in 4/12 PDT patients and 10/21 CTM patients. Favorable immediate neurological outcomes (GCS ≥ 11T) were observed in 8/12 PDT patients and 8/21 CTM patients, while 3 PDT patients remained anesthetized until death and 7 CTM patients died within the first 72 hours without recovery attempts.

Conclusions: In experienced hands, PDT could be a legitimate clinical option for the surgical airway in cases of CICOV. CTM may be more suitable for practitioners who encounter CICOV infrequently.

Introduction: This study, conducted between December 2015 and March 2018 at a single university hospital, explored the feasibility and safety of opioid-free anesthesia combined with preoperative thoracic paravertebral block (ThPVB) for patients undergoing elective video-assisted thoracoscopic surgery (VATS). The aim was to assess the impact of this approach on postoperative pain levels and opioid consumption.

Material and methods: Sixty-four patients scheduled for elective VATS were randomly assigned to either the intervention group, receiving opioid-free anesthesia with ThPVB, or the control group, managed with standard general anesthesia. Postoperatively, both groups received oxycodone patient-controlled analgesia along with non-opioid analgesics. Pain intensity was measured using the Numeric Pain Rating Scale (NRS) and Prince Henry Hospital Pain Score (PHHPS). The total dose of postoperative oxycodone and the occurrence of opioid-related adverse events were recorded during the 24-hour follow-up period.

Results: Patients in the intervention group showed significantly lower pain levels at 20 and 24 hours post-procedure ( P = 0.015, P = 0.021, respectively) compared to the control group. Notably, oxycodone consumption at 24 hours was significantly higher in the control group ( p < 0.0001). No serious adverse events were observed during the study period.

Conclusions: This study demonstrates the feasibility and safety of opioid-free anesthesia combined with ThPVB for elective VATS. The approach significantly reduces postoperative pain and the need for opioids, supporting its potential as an effective and balanced perioperative anesthetic strategy.

The requirement for preoperative dental assessment (PDA) to prevent periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) seems to be a common practice at least in some orthopaedic centres. There are few studies which have examined this intervention. Routine referral of patients for routine PDA increases costs and potentially prolongs the time to the procedure. In order to investigate the effect of PDA on the frequency of PJI after TJA, we conducted a systematic review with meta-analysis of observational studies including adult patients undergoing TJA. The search for eligible studies was performed across MEDLINE, EMBASE, Web of Science, and Google Scholar databases. The intervention group consisted of patients who had undergone PDA, while the control group consisted of patients without PDA. The main outcome was the presence of PJI. In addition to traditional meta-analysis, a Bayesian analysis and trial sequential analysis were performed. The analysis included five observational studies. Considering PJI as an outcome, the total risk of bias was assessed as serious. A total of 23 175 patients were included in those studies, of whom 12 324 had a PDA. There was no effect of PDA versus no PDA on the incidence of PJI (OR 0.86, 95% CI: 0.50-1.49; I² = 42%). Bayesian analysis showed that the posterior probability of PDA reducing the frequency of PJI was 69.1%. Thus it was concluded that, in patients undergoing TJA, it remains unknown whether PDA influences the occurrence of postoperative PJI. There is insufficient evidence to support performing this intervention routinely. The health care systems and individual organisations will likely need to make decisions on continuation of such programmes on the basis of this limited amount of information.